A hard place to heal – Portland’s Bridgeview Program

For some residents, Old Town transitional housing facility offers too much temptation • ‘Harm reduction’ principles may be at odds with care of addicted mentally ill

For David Hain, the Bridgeview Program was a lifeline. A recovering alcoholic, private investigator and former captain in the Multnomah County sheriff’s office, he started drinking last year after a long period of abstinence, lost his condo and eventually sobered up at Hooper Detox. As Hain contemplated his future — he was technically homeless — a counselor suggested he check into the Bridgeview, a transitional housing facility in Old Town. Hain jumped at the chance. When he moved into the Bridgeview in October, however, Hain was surprised to discover that alcohol and drugs were almost as common as the cockroaches scuttling across the floor. Around the first of the month, when the Social Security checks rolled in, the elevators reeked of booze. He often saw residents displaying the heavy-lidded nod of narcotics or the manic frenzy of methamphetamines. “I’m not blaming anybody,” says Hain, who managed to stay sober during his four-month stint at the Bridgeview. “But it’s really hard on people who are trying to stay clean and sober when they know there’s a party going on in the room next door — it triggers their cravings.” Located on the corner of Northwest Everett Street and Broadway, the Bridgeview is one of Old Town’s most bizarre institutions. In former times, it was a flophouse known as the Golden West Hotel — but no one seems to agree on exactly what it is now. Officially, the building is designated as providing 63 units of transitional housing for the chronically mentally ill. In reality, it is a sort of institutional Frankenstein: an asylum without gates, a hospital without doctors. It is simultaneously a sanctuary and a shooting gallery, and a monument to the challenges of treating mental illness in the era of deinstitutionalization. The Bridgeview is managed by Cascadia Behavioral Healthcare, the private nonprofit mental-health agency that treats 75 percent of Multnomah County’s low-income residents who have mental illness. Cascadia’s chief executive officer, Leslie Ford, was traveling out of state as the Portland Tribune went to press and was unavailable to discuss the Bridgeview; no one else at the agency was willing to speak on the record.

“You’ll have to talk to Leslie on this one,” Cascadia spokesman Jim Clay says.

Nonetheless, several players in the mental health community say the Bridgeview does a good job given limited resources and a difficult clientele. “I feel like their services have been adequate,” says Vicki Skryha, the community housing, employment and supports manager for the addictions and mental health division of the Oregon Department of Human Services. “People are trying to do the best they can.” Others, however, view the conditions at the Bridgeview — particularly the levels of drug and alcohol use — as an indictment of the approximately $870,000 of taxpayer dollars that the program consumes every year. “It doesn’t pass the ‘relative test,’ ” says psychiatrist Peter Davidson, the former medical director of Multnomah County’s mental health system. “It’s not a place you’d want your mother or father in.” The Portland police, who have responded to the Bridgeview 89 times in the past year, do not view the building as a menace to public safety. Nonetheless, officers remain wary of the program. “When you go to that address, you never know what you’re going to walk into,” Sgt. Matt Engen says. Issues included prostitution It is difficult to assess the precise extent of drug and alcohol use at the Bridgeview. Police transported intoxicated guests or residents to Hooper Detox on eight occasions last year, but that does not necessarily reflect what goes on inside the building. “The police bureau doesn’t stick its nose too far into what the social service providers are doing,” Engen says. “It’s not our business to come in and try to manage their properties. If it happens inside and no one complains, we’re not going to go sniffing around.”

In 2006, for example, a Multnomah protective services investigator looked into a case in which a female resident of the Bridgeview accused another female resident of acting as her pimp, forcing her to prostitute herself and to shoplift to support their crack habits. The report, obtained by the Portland Tribune through a public records request, was heavily redacted, and many details remain unclear. It appears that once apprised of the situation, Bridgeview staff took steps to protect the alleged victim. Nonetheless, the report suggests that trading sex or money for drugs was not uncommon at the Bridgeview, noting, “Witness stated that alleged victim had approached witness multiple times, offering to have sex with witness for money or drugs … (and) stated that another resident had pimped alleged victim also, and alleged victim had sustained a cut on (her) forehead as a result of one of the sexual encounters.” Three bodies have been discovered at the Bridgeview since November 2003. Due to confidentiality policies, it is difficult to learn the cause of death, but police records show that at least one victim died of a drug overdose. In May 2006, a male resident was found dead in his room, lying face up on the floor, his sleeve pushed up around his elbow. A syringe, a spoon and a small baggie with residue of a white powder lay on the writing table. It’s no surprise that people suffering from persistent mental illness would turn to alcohol and drugs. What is perhaps more surprising is that, at the Bridgeview, this behavior stems from an official policy of deliberate toleration. Housing comes first The Bridgeview operates on the principle of “harm reduction”— a public health philosophy that attained prominence in the United States during the early stages of the AIDS epidemic in the mid-1980s. Rather than pretend that all risky behavior can be eliminated, harm reductionists seek to minimize the damage inflicted by that behavior, for example, by providing condoms to teenagers and clean needles to drug addicts. In the world of chronic mental illness, the principle of harm reduction means putting a roof over someone’s head before attempting to treat their illness, according to Joan Rice, quality assurance manager for Multnomah County’s mental health and addiction services division. “They need shelter before they can get treatment,” Rice says. To that end, Rice explains, the Bridgeview is a crucial element in Portland’s system; it is the first rung of the ladder: a bare-bones respite intended for people to escape the streets, stabilize on their medication and — with luck — find permanent housing elsewhere. Staff are supposed to guide residents toward social norms instead of evicting them for minor infractions. At the Bridgeview, alcohol is banned from the common areas and hallways, but may be consumed freely in a resident’s room. Drugs are officially forbidden, but tolerated in practice, say people familiar with the program; Bridgeview staff recently installed special biohazard containers in the bathrooms so that residents can safely dispose of dirty needles without endangering other residents, some of whom habitually root through the trash. There is some evidence to suggest that the harm reduction approach works at the Bridgeview. Of the approximately 160 individuals who stayed in the building last year, 60 percent eventually were placed in permanent housing, according to statistics from Multnomah County — an impressive figure that Rice views as a “testament to the good work that they do.” Others contend that the Bridgeview’s brand of harm reduction is poorly implemented. The building’s residential counselors, who form the backbone of its support services, are paid as little as $10.33 per hour. On a typical shift, three of the counselors manage 64 residents, some of whom can turn violent if they do not take their medication. The combination of low wages, high stress and personal danger contributes to high turnover and an atmosphere of defeat. “We are doing damage control,” one mental health professional familiar with the program says. “It’s like, Dude, if you’re shooting up, don’t leave your needles lying around.” That attitude certainly runs against the conventional wisdom, which holds that chronic drug and alcohol use is extremely destructive to people with mental illness.

“People with psychosis really should stay away from drugs because they tend to undermine their hold on reality,” Portland psychiatrist and addiction expert Marvin Seppala says. “Plus which, it’s hard to take your meds if you’re getting high every day.” Downward spiral continued Angel Crowe had everything going for her. In 1992, she was the homecoming queen at Lincoln High School. A vivacious brunette, she won the election because, as she puts it, she managed to unite “the Goths, the rockers and the jocks … or maybe they just thought it was a joke, I don’t know.” Today, her good looks are camouflaged by a Red Sox ball cap and the emotional baggage of years of alcoholism. Shortly after she graduated from Lincoln, she began suffering from panic attacks, which she doused with vodka. For more than a decade, she was able to function, working a series of restaurant jobs and taking care of her daughter. Three years ago, her life spun out of control and she spiraled from one desperate situation to another. In 2006, she moved into the Royal Palm hotel, a Cascadia facility similar to the Bridgeview. At the Royal Palm, she developed an intimate relationship with a counselor, which ultimately resulted in the counselor losing his job and Crowe contemplating suicide. Eventually she moved to a little room on the fifth floor of the Bridgeview, with a little bed and a table, away from the unpleasant reminders of the scorched affair. At the Bridgeview, Crowe fell in with another resident named Ken Clowers. “That’s when all hell broke loose,” her mother, Josie, says with a sigh. Crowe’s fragile recovery collapsed under the impact of her relationship with Clowers, who had a history of mental illness and involvement with the criminal justice system. They drank vodka together, slept together and fought with each other. Far from being an island of stability, Crowe says, the Bridgeview was more like a den of vice. “There’s a lot of trading and stuff going on,” she says. “Me being an alcoholic, I wasn’t blameless. I went to (Alcoholics Anonymous) groups, but it seemed like nobody was there. Some people only attended to get gift cards. On the first (of the month), everybody goes nuts. Crack, meth, pot, drinking — you name it.” Asked about the Bridgeview staff’s attitude toward drug and alcohol use, Crowe simply clamps her hands over her ears. Clowers and Crowe were both evicted from the Bridgeview last summer, but their tumultuous relationship continued for months in an on-again, off-again pattern. After a series of reconciliations and breakups, last month they checked into a Motel 6 on Southeast Powell Boulevard. They drank; they quarreled. Crowe wanted to leave, but Clowers allegedly held her against her will. The police Special Emergency Reaction Team team responded to the scene — there was some confusion about whether Clowers had a gun — and eventually arrested him on kidnapping charges. After the standoff, Crowe disappeared for a few days, melting back into the streets, to the despair of her mother. She currently is staying in a women’s shelter, hoping to find an alcohol-treatment facility that will take her. “I should have learned my lesson,” she says, tears rolling down her cheek, her mouth clamped into a circumflex. “I get blindsided by the panic, and I just freak out.” Changes may be in store Despite the challenges, both detractors and defenders of the Bridgeview agree that the population it serves is vulnerable, and better off inside than outside. “Whatever difficulties we have had with Bridgeview, imagine what it would be like if that population were living out on the streets,” Engen says. “We’d rather have them in supported housing. Is there going to be some drama? Yes. But is it beyond what is tolerable? No. If it went away, I’d be horrified.” Earlier this year, it looked like big changes were in store for the Bridgeview. Its lease in the Golden West was due to expire in July and the program was slated to move into the gloomy Grove Hotel, which recently was purchased by the Housing Authority of Portland and is undergoing renovation. Now, however, it appears that the Bridgeview’s landlord, Central City Concern, is willing to extend its lease at the Golden West for another couple of years. Meanwhile, the Housing Authority of Portland is making plans to build an $8 million six-story structure custom-designed for the Bridgeview at Southwest 13th Avenue and Clay Street. Until then, the anonymous building at Everett and Broadway will continue to conduct business as usual. Residents will smoke cigarettes on the sidewalk outside a small cafe. The gaunt man will sit in the lobby, mumbling and chuckling to no one in particular. In the common room, the TV evangelist will preach to the empty chairs.